Weight gain can be frustrating but understanding the reasons behind it, and why it’s so hard to shift, can help you tackle it – without faddy diets
• Many women gain weight during perimenopause and menopause despite not changing their eating or exercising habits
• Learn the physiological changes that lead to weight gain
• Realistic, everyday ways to help control your weight
One of the most common questions I get asked by women in my consultations at Newson Clinic is, ‘Why am I gaining weight?’. Another is, ‘How can I shift the weight I’ve gained?’. In a survey of 5,744 women, almost a quarter (23%) said they’d gained weight during perimenopause or menopause [1]. While in some cases the weight gain can be modest, it can still feel extremely unfair if you’ve not changed your eating or exercise habits and lead a healthy lifestyle.
Weight gain isn’t a vanity issue – it can affect self-confidence and self-worth, and have health consequences. It can be demoralising when you’ve tried various methods to shift the weight to no avail. But understanding the physiological reasons behind your weight gain can help – it can be reassuring to realise you may not be “to blame” but also help identify the best ways to address weight gain.
Why can weight gain occur during perimenopause and menopause?
The reasons for weight gain are multifactorial. For some women, symptoms – such as fatigue, muscle and join pain, vaginal dryness or low mood – can reduce or stop the desire and/or ability to exercise or eat a healthy diet. It’s not easy to cook a fresh, balanced meal if you’re feeling anxious. Or go for a run if you ache all over. Symptoms are caused by changing hormone levels but hormonal changes also impact your body in ways you may not realise.
During menopause, levels of oestradiol, which is an anti-inflammatory type of oestrogen reduce. Oestradiol regulates how your body uses insulin, increases muscles strength and muscle recovery, and suppresses your appetite. When there's a lack of oestradiol, your sympathetic nervous system goes into flight mode and your body releases more glucose to flee. If this isn't used up, more insulin is triggered, which then packs glucose away as fat. To get more oestrogen, your body produces oestrone, a type of oestrogen that is produced in your fat cells and causes your body to lay down more abdominal fat. It is also inflammatory and plays a role in craving foods high in sugar and fat. So if you find yourself constantly craving things you know you “shouldn’t” eat, this can be a reason why. It also explains why it might take you longer to recover from exercise or your muscles feel more achey – oestradiol not only increases muscle mass it produces antioxidants that mop up free radicals, which helps with muscle recovery, so any loss of oestradiol can be keenly felt.
You can read more about the metabolic changes, insulin resistance and changes in fat distribution that occur in our article Why can’t I shift my menopause belly?
Progesterone also has a role in regulating your metabolism – as a relaxing hormone it can help to promote sleep plus it helps to control appetite. A lack of progesterone can reduce your energy consumption and trigger an increase in fat storage. Low progesterone can also contribute to sweet cravings – if you have PMS or PMDD you may have noticed you get sugar cravings before your period is due (which is when progesterone levels are low).
Perimenopause and menopause can coincide with a drop in testosterone, a hormone that helps with muscle mass, energy levels and quality of sleep, all of which can have an impact on weight gain.
RELATED: The importance of testosterone for women
How can I tackle weight gain?
There is no one strategy that will work on its own – just as the reasons behind weight gain can be multifactorial, so too is the approach needed to tackle it. This can include rebalancing your hormones with HRT, and diet, exercise, sleep and stress relief strategies.
Rebalance your hormones
While HRT is not prescribed for weight loss, it is the first-line treatment for perimenopausal and menopausal symptoms. Many women find that once their hormones are restored or rebalanced, they can lead a healthier lifestyle – exercise becomes possible again, energy returns and mood can improve. It is much easier to lead a healthy lifestyle when you are not battling symptoms such as hot flushes, muscle and joint pains and vaginal dryness. Low oestradiol can alter the levels of particular bacteria in your gut microbiome, which then slow down metabolism and trigger sugar cravings. Taking HRT can help with your gut microbiome [2], which can in turn impact your weight.
Testosterone can help to prevent sarcopenia [3], increase energy and motivation. In a Newson Research study 73% of female athletes who were using testosterone felt it helped them return to or increase physical activity [4].
Taking HRT and testosterone can improve your metabolism [5]. Many women find that after starting HRT, they lose weight they have gained.
Consider your diet
1. Portion size
You may need to eat less compared to when you were younger. It’s easy to put the same amount of food on your plate as you’ve always done but consider your needs – do you need as much fuel now?
2. Nutritional needs
Appetite can reduce with age, but your nutritional need remains the same. If you feel less hungry and eat less, consider what you’re eating. For instance, if you grab a bag of crisps for lunch as you’re not that hungry, you’ll not be getting the nutrients you need. Choose colourful foods that will improve your vitamins and mineral intake - eat the rainbow and try to eat up to 30 different plant types across the week, which can include vegetables, fruit, wholegrains, legumes, nuts and seeds, herbs and spices.
3. Cutting calories is too simplistic
If you go on a crash diet, your body will think it's starving so will stockpile fat and store its energy. Then your metabolic rate will readjust. Many women tell me they’ve gone on a diet, lost a stone relatively easy, but then found it much harder to lose more weight even when following the same diet. This is because their metabolic rate has readjusted so to maintain weight loss, they’ll need to reduce calories even more, which is not sustainable so will result in rebound weight gain.
4. Forget fad diets
So many of my patients talk about a specific diet - a ketogenic diet, a no-carb diet or protein-only diet, for instance. But all calories are not equal, all fats are not equal, all carbs are not equal, etc. Avocados are high in fat and calories, but they are nutrient dense and can support a healthy metabolism.
5. Be clever with carbs
Carbohydrates are important for energy levels. Choose slow-release complex carbs – such as wholegrains, vegetables and fibre-rich fruit – as these take longer to digest and provide a sustained release of energy and stable blood sugar levels.
6. Hungry or emotional?
Food can be a pick-me-up but it is worth considering whether you are eating because you are hungry or you have low mood, are bored, feel in need of a treat etc. Before you reach for a snack, tune into how you are feeling.
7. Avoid ultra-processed foods
Ultra-processed food promotes insulin resistance. It is easy to eat – it’s designed to have the fats and sugars that you crave – but because it’s not nutrient dense, you tend to eat it quickly, which delays the signal to the brain that you’re full, so you eat more of it than you need.
RELATED: Ultra-processed food unwrapped with Henry Dimbleby
8. Prime yourself with protein
Protein keeps you fuller for longer – ensure your breakfast contains protein to get off to a good start. Protein also helps regulate insulin and metabolism and it helps regulate your circadian rhythm and promote weight loss.
9. Increase your fibre intake
Fibre fills you up and can help with long-term weight loss [6] – aim for 30g a day.
10. Consider time-restricted eating or intermittent fasting
Going without food for 12 hours overnight gives your gut time to rest and improves insulin sensitivity. It’s not suitable for everyone, however, including those with a history of eating disorders.
11. Curb or cut out alcohol
You may find you drink more alcohol during perimenopause and menopause, perhaps because you're feeling anxious, lower in confidence, or in low mood or in the hope it will help you sleep. However, alcohol can disrupt your oestrogen metabolism, affect your gut microbiome and stimulate your appetite, which can lead to overeating.
12. Improve your gut microbiome
A poor microbiome increases the risk of obesity, but during menopause there is a reduction in gut microdiversity. To improve your gut microbiome, aim to eat 30 different plants (fruit, vegetables, nuts, seeds, pulses, herbs and spices) a week, fermented foods such as kimchi, kombucha, kefir and sauerkraut and prebiotics, which are found in garlic, onions, leeks, asparagus, green bananas.
Tailor your exercise
If you think of exercise as something you have to do or as something to cancel out what you’re eating, it’s time to reframe your thoughts. As well as all the obvious health benefits, exercise can make you feel better and improve your self-esteem. Pick a form of movement that you enjoy – there’s no need to do punishing sessions at the gym if you prefer a walk with a friend. If you enjoy it, you’re more likely to stick with it. Exercise, as well as helping improve sleep and stress levels, can also help ease menopausal symptoms.
Exercise has a beneficial effect on weight for a number of reasons. It builds muscle, increases insulin sensitivity and promotes a healthy gut microbiome - when you exercise, oxygen is shifted from your gut to your muscles, which increases heat and allows the good bacteria to grow.
You can find out more about beneficial types of exercise in our article How much should I exercise during perimenopause and menopause? but as you get older, strength training becomes increasingly important. Strength training, which can include yoga, Pilates and lifting weights, helps increase your metabolism so you burn more calories, improve insulin sensitivity and reduce inflammation. Aim to do strength training at least twice a week.
Remember that exercise will increase your appetite, so you need to make sure you eat enough calories to sustain your workouts.
Prioritise sleep
Sleep disturbances during perimenopause and menopause are common but when you don’t get enough sleep, your blood sugar levels are also disrupted. Levels of ghrelin hunger hormone go up, while levels of leptin, the hormone that signals when you feel full, go down. If you’ve not had a good night's sleep, you can consume up to 35% more calories, which will affect weight gain. If you are trying to lose weight, really prioritise getting a good night’s sleep: consider your caffeine and alcohol intake, the timing of meals and snacks, sleep hygiene, keeping your bedtime consistent, even at weekends, and possibly supplementing with magnesium.
RELATED: Magnesium and hormone health
Manage your stress
The hormones oestradiol, progesterone and testosterone all have important roles in the brain so when levels fluctuate and reduce, this can lead to symptoms including anxiety, irritability, low mood, and increased stress levels. In response to stress, the hormone cortisol stimulates fat metabolism and can increase blood sugar levels, which can cause you to crave high-calories food.
To reduce your stress levels, try to identify things that you enjoy, be it being out in nature, meditation, art or reading. You can also try practices such as reflection and positive thoughts, but don’t overlook the importance of breathing.
Breathing disorders become much more common during menopause - nasal breathing can help stimulate your parasympathetic nervous system (rest and digest system), which can help with stress management.
Should I consider weight-loss jabs?
Weight loss drugs such as Ozempic, Wegovy and Mounjaro, also known as GLP-1s, were originally developed for the treatment of Type 2 diabetes. By reducing appetite and stimulating insulin production they can help you lose weight. While these drugs can have a role in weight loss in some people, there have been concerns from people not getting enough nutrients while taking them, to rare side effects such as allergic reaction, pancreatitis and kidney damage.
If you are considering weight-loss jabs, it would be sensible to first address your hormones and your lifestyle as these steps can be very effective. If you do still struggle with your weight, the important thing is to go to an experienced clinic where you will be monitored closely. It is important to also incorporate strength training when using these medications as weight-loss jabs are known to result in muscle loss, which you will want to avoid.
